Advancing Academic and Practical Knowledge To Prevent Infections From Hospital to Home

"Understanding how to prevent infections in all settings of care is critical to keeping patients safe."

Keeping patients safe from harms such as healthcare-associated infections (HAIs) is an AHRQ priority that is shared by grantee Susan Huang, M.D., M.P.H., Professor of Medicine in the Division of Infectious Diseases and Medical Director, Epidemiology and Infection Prevention, at the University of California, Irvine School of Medicine. Using funds from AHRQ, Dr. Huang has advanced the field of infection prevention by identifying how HAIs are transmitted and discovering new approaches to prevent them.

HAIs are a common threat to patients in all settings of care. Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common HAIs. It is difficult to treat and to prevent because it's resistant to some antibiotics and is easily transmitted from person to person.

People who are colonized with MRSA have the germ on their bodies but are not sick from a MRSA infection. If a person is colonized with MRSA, they have an increased risk of developing a MRSA infection and also can pass the MRSA germ on to others who then may develop an infection. MRSA colonizes or infects 1.8 million hospital patients each year. Using AHRQ funding, Dr. Huang set out to address this problem by leading research projects that investigated how to prevent MRSA transmission.

In a project funded in 2010 (Project CLEAR—Changing Lives by Eradicating Antibiotic Resistance), Dr. Huang's research team assessed the value of sending patients home from the hospital with an antiseptic regimen to decolonize or remove MRSA from their bodies. Removing MRSA from the patient cuts the risk of infection and transmission of the germ to other people. This prevents new or recurrent MRSA infections and reduces unnecessary trips back to the hospital.

Hospital admission also is a concern for three million nursing home residents who are affected by HAIs each year. These infections are particularly problematic in nursing homes because residents are older and more prone to having health conditions that increase their risk of an infection.

Dr. Huang and her team studied this problem with funding from AHRQ in 2015. The 5-year PROTECT Trial (Protecting Nursing Home Residents from Infections and Readmissions)—a cluster randomized trial of 28 nursing homes in California, tested the use of a bathing routine, known as universal decolonization, to prevent infections. Universal decolonization includes using over-the-counter antiseptic solutions to clean the skin and nose of residents to remove MRSA and other dangerous germs from their bodies. The nursing homes that used universal decolonization prevented two infection-related transfers to the hospital each month and cut the overall amount of multi-drug resistant organisms in the nursing home, such as MRSA.

Also in 2015, Dr. Huang received a 3-year AHRQ grant, the SAFER Lines (Standardizing Assessment for Effective Response) project. Her team evaluated a web-based comprehensive care bundle that trains out-of-hospital care providers and patients to manage central lines by learning to apply proven infection practices.

With a continued focus on reducing HAIs, Dr. Huang received a 5-year AHRQ grant in 2022 to compare the use of targeted decolonization with routine post-discharge wound care to reduce post-discharge surgical site infection (SSI) following open colon or small bowel surgery. The Decrease SSI Trial (Decolonization to Reduce After-Surgery Events of Surgical Site Infection) project is expected to end May 31, 2027.

These grants build on Dr. Huang’s earlier AHRQ-funded work in the REDUCE-MRSA trial, which compared universal decolonization to standard infection prevention practices in hospital intensive care units (ICUs). The ICUs using universal decolonization reduced all-cause bloodstream infections in their patients by more than 40 percent. This research was completed in 2013 and protocols developed during the study are now common practice worldwide.

Dr. Huang also has participated in AHRQ-funded research projects that advance the appropriate use of antibiotics for children and the use of claims data for surveillance of surgical site infections. Her work to advance the academic and practical knowledge of infection prevention has informed the Healthcare Infection Control Practices Advisory Committee, which advises on infection prevention and surveillance practices used throughout the U.S. healthcare system.

Dr. Huang has received numerous awards for her advances in HAI prevention, including the Society for Healthcare Epidemiology of America's 2012 Investigator Award and the Infectious Disease Society of America's 2016 Oswald Avery Award for Early Achievement.

Related AHRQ Resources

• AHRQ’s Healthcare-Associated Infections Program.
• AHRQ Safety Program for MRSA Prevention.
• Decolonization – Universal and Targeted.
• Toolkit for Decolonization of Non-ICU Patients With Devices.

Principal Investigator: Susan Huang, M.D., M.P.H.,
Institution: University of California, Irvine Medical Center
Grantee Since: 2001
Type of Grant: various

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